Saddleback F.M.J. Elderly Care Home

Type of visit: Required - 1 Year

On November 21, 2025, Licensing Program Analyst (LPA) Garlli Tat conducted an unannounced visit to the facility for the purpose of a required annual inspection. LPA explained the purpose for the visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted the facility administrator (AD) Maria Jimenez about the visit. For this visit, there are two staff members on duty, both of which are background cleared and associated. AD later arrived to assist with the inspection. The PUB475 ‘See Something, Say Something’ poster was observed to be located in the dining room. LPA observed the Administrator's Certificate for Maria Jimenez, which expires on April 20, 2027. The facility is a Residential Care facility for the Elderly (RCFE) licensed for six residents, six of which may be non-ambulatory, none of which may be bedridden, and hospice waiver for two. LPA toured the interior and exterior portions of the facility with AD. For this visit, there are a total of six non-ambulatory residents in care, two of which are on hospice, and none are bedridden. The facility is a single-story home. There are a total of six bedrooms, three are three resident bedrooms, and three staff bedrooms. LPA toured each bedroom with the AD and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and free of any hazards. LPA observed the staff bedrooms to be kept locked and inaccessible to residents in care. Smoke and carbon monoxide detectors as well as auditory exit alarms were tested and operational. There are a total of two and a half bathrooms, one and a half bathrooms are for residents and one is for staff. Continued on LIC 809-C. Bathrooms were observed to be in good repair, toilets and faucets were operational and showers were equipped with grab bars and non-skid floor mats. Water temperature in the bathrooms were measured to be between 105.4 and 109.9 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked in the kitchen cabinet and inaccessible to residents in care. Fire extinguisher was mounted and located in the kitchen. Fire extinguisher needs to be charged and was purchased on January 17, 2023. LPA observed the emergency disaster and evacuation plan, which is posted in the hallway. LPA observed the facility conducted their last emergency disaster drill on February 2, 2025. Facility had back-up emergency food and water supply, located in the garage. LPA observed that the First Aid kit had all the required components. Medications were observed to be locked in a storage room in the hallway. Toxins were observed to be locked in the laundry room, inaccessible to residents in care. LPAs observed the door leading to the attached two car garage is kept locked and inaccessible to residents in care. The garage is used for storage and the emergency food is kept in the garage. For the exterior portion, LPA observed patio furniture under shading. There are two exit gates in the backyard that can be opened in case of an emergency. There is a shed in the backyard which is locked and used for storage. There is a pool in the backyard with a secured fence around it. During this visit, six resident files and three staff files were reviewed. All staff are background cleared and associated with the facility. LPA reviewed residents’ medication and medication records and two resident interviews were conducted. Based on today's observations, there are two deficiencies being cited per Title 22 of the California Code of Regulations. There are two technical violations (TV). An exit interview was conducted with Maria Jimenez. This report was reviewed with the administrator and a copy was provided at the end of the visit. Appeal Rights were reviewed.the state’s words, verbatim · CDSS document, Nov 21, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. LPA Tea was greeted and granted entry into the facility by Administrator (AD) Maria Jimenez and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, with a hospice waiver for two. Currently there are six residents, of which there are none on hospice during today's visit. At around 9:20 AM, LPA Tea reviewed six resident files and two staff files. There were discrepancies noted in the review of resident and staff files. Administrator certificate expires on April 20, 2025. Last facility disaster drill was conducted on February 20, 2025. LPA Tea along with caregiver toured the facility around 10:25 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 3 resident bedrooms, 3 staff rooms, 3 bathrooms, living room, dining room, kitchen, family room, laundry area and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms, and they are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 107.9 degrees F and 113.3 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. There are cameras with no audio in the common areas to monitor the safety of the residents. The house is currently going under some small renovations where they are rewiring the wires and cords going throughout the facility. The walls will be patched up and repainted once they finish with the minor repairs. First aid kit had all the required elements including bandages, dressings, tweezers, thermometer, and scissors. Kitchen was inspected. Kitchen appliances are operational during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps Annual continuation on LIC809-C locked in the closet with medication. LPA also observed toxin substances to be locked and inaccessible to clients in care underneath the sink and secured in the garage. The fire extinguishers throughout the facility were fully charged. LPA toured the outside grounds and there is ample seating with shade and two exit gates on both sides of the facility are self-latching and operational. There is a pool in the backyard with a secured fence around it. LPA observed emergency supplies, food, and water supply in the garage. Facility provides activities based on resident interests. Residents go out for walks; they listen and dance to music. Staff sometimes do their nails. There is someone that comes on Thursday to conduct activities with the residents like exercises. At the time of annual visit, residents were seen watching television and having lunch later during the visit. Around 10:54 AM, LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. LPAs interviewed residents regarding their quality of care and spoke to staff present regarding care provided. The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Maria Jimenez and a copy of these reports were given to the facility along with a copy of the LIC 858; 859;809-D, and Appeal Rights.the state’s words, verbatim · CDSS document, Feb 24, 2025

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Ruth Martinez made an unannounced case management inspection to follow-up on an incident report received by Community Care Licensing on January 30, 2024. LPA spoke to Maria Jimenez, Administrator and explained the reason for the visit. Incident report indicated that on January 27, 2024 at about 6:25am, that while the two caregivers on duty were assisting other resident in the morning routine, it was observed that resident (R1) was not in their bedroom. Administrator immediately notified the responsible party, primary care physician and called local police department. Administrator was informed R1 was found at the near by park at 6:30am and 911 was called for assistance. R1 was transported to the local hospital for evaluation and was picked up by Administrator and brought back to the facility. During today’s visit, LPA interviewed AD who confirmed the details of the incident reported. LPA took a physical tour of the facility and observed residents in dinning table having breakfast and reviewed R1’s records and observed all auditory devices in doors were functioning. R1’s Physicians report indicates R1 has a dementia diagnosis but does not indicate R1 had wandering behavior. Resident appraisal dates May 13, 2023 indicates R1 did not have wandering behavior but likes to explore her environment. Preplacement indicates R1 is active and confused/forgetful due to cognitive impairment. This was the first elopement incident for R1 and first change of condition noticed. R1’s primary care doctor adjusted medication and adjustments were made to routine of care for R1 to avoid this incident from occurring again. R1 has been responding well to adjustments and has not had any other incidents since. R1 remains in the facility with no further issues to report. Due R1’s change of condition/no prior wandering behavior indicated medically and in observation and measures already taken by the facility to ensure the safety of R1 and as well as the other residents in care, LPA is issuing an LIC 9102 (Technical Advisory) in lieu of a citation. This report was reviewed with the facility representative and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Feb 20, 2024